Hospital Readmission in Alcohol Use Disorder Patients: The Role of Anti-Craving Medications and Discharge Disposition.

Background: Alcohol use disorder (AUD) results in frequent hospital readmissions. Although the literature has shown the efficacy of anti-craving medications (ACM), they are infrequently prescribed upon discharge. The outcomes of discharge to substance use treatment facilities (STF) have also not been fully explored. This study seeks to determine the impact of ACM as well as discharge to STF on readmissions for people with AUD. Methods: This retrospective case-control study analyzed encounters made within HCA Healthcare hospitals across the United States from 2016 to 2018 for adults with AUD. The case definition was the presence of ACM defined as acamprosate or naltrexone upon discharge as well as discharge disposition (STF vs. all others). The main outcomes were the likelihood of 30- and 90-day readmission and blood alcohol concentration (BAC) on 30-day readmission in cases versus adults with AUD declining/not referred to an STF or not using ACM. The controlled variables included age, sex, race, and insurance status. Results: A total of 14 691 patients were identified for the study. Of these, 3308 patients were prescribed ACM and 1125 patients were discharged to an STF. Patients without ACM were 1.18 times more likely to be readmitted within 30 days (95% CI, 1.07-1.30; P = .0005). Patients discharged to an STF were 1.57 times more likely to be readmitted within 30 days (95% CI, 1.37-1.79; P < .0001), but these patients had a BAC that was 26.74 units lower on 30-day readmission than those who were not discharged to an STF. Conclusion: The prescription of ACM on discharge was associated with decreased 30-day readmission rates. The lower BAC of those who were readmitted within 30 days suggests discharge to STF may be beneficial for the treatment of AUD in the longer term. Practitioners are encouraged to prescribe ACM for people admitted with AUD to reduce the likelihood of 30-day readmission.